The control of bleeding is essential and critical in surgical procedures to minimize blood loss, postsurgical complication and to shorten the duration of the surgery in the operation room. Oxidized cellulose, due to its bioresorable, bactericidal and hemostatic properties, has long been used as a topical hemostatic wound dressing in a variety of surgical procedures, including neurosurgery, abdominal surgery, cardiovascular surgery, thoracic surgery, head and neck surgery, pelvic surgery, and skin and subcutaneous tissue procedures. Examples of hemostatic oxidized regenerated cellulose absorbable hemostats commercially available include Surgicel® absorbable hemostat, a knitted fabric of oxidized regenerated cellulose (ORC), Surgicel Nu-Knit® absorbable hemostat, a dense ORC fabric and Surgicel® Fibrillar absorbable hemostat, mircrofibrils of ORC, all available from Johnson & Johnson Wound Management Worldwide, a division of Ethicon, Inc., Somerville, N.J., a Johnson & Johnson Company.
Although the absorbency of body fluid and the hemostatic action of currently available oxidized cellulose hemostats are adequate for applications where mild to moderate bleeding is encountered, they are not known to be effective to prevent or stop severe bleeding where a relatively high volume of blood is lost at a relatively high rate. In such instances, e.g. arterial puncture, liver resection, blunt liver trauma, blunt spleen trauma, aortic aneurysm, bleeding from patients with over-anticoagulation, or patients with coagulopathies, such as hemophilia, etc., a higher degree of hemostasis is required quickly.
In an effort to achieve enhanced hemostatic properties additional chemical moieties, such as calcium, or biologics, such as fibrinogen, thrombin and fibrin, have been bound to oxidized cellulose fabrics. These biologics-bound combination products require the use of proteins derived from human or animal blood or tissue. This imposes a risk of blood-borne pathogen or zoonotic disease transmission by the products. Hemostatic wound dressings containing hemostatic agents are known. Woven or nonwoven fibrous materials are prepared by coating the materials with solutions containing ammonium salts of cellulose derivatives, e.g. free acid cellulose glycolic acid ether and free acid hydroxyproprionic acid ether. The coated material then is dried and preferably heated at elevated temperatures, e.g. 175-350° C., to obtain surgical dressings having insoluble hemostatic agent impregnant.
Medical sealants and adhesives, such as cyanoacrylate-based medical adhesives, function as hemostats only in very slowly diffusing bleeding. Sealant systems, usually involving chemical cross-linking steps, are not effective hemostatic agents on actively oozing or severely bleeding wound sites. The mobility of liquid sealants also makes it hard to apply manual or digital compression to help achieve hemostasis.
Currently available oxidized cellulose hemostats noted above are knitted fabrics having a porous structure. They exhibit good tensile and compressive strength and are flexible such that a physician can effectively place the hemostat in position and maneuver same during the particular procedure being performed.
While the various noted hemostatic materials and agents are known for use with respect to providing hemostasis for low to normal bleeding, to date none of the noted hemostats, or combinations thereof, have been shown to be effective in providing hemostasis in cases of severe bleeding, e.g. high volume and high rate of bleeding. The present invention provides such a hemostat that provides hemostasis in cases of severe bleeding.